PB2160: MULTIPLE MYELOMA IN THE ELDERLY: A MONOCENTRIC EXPERIENCE OF THE HEMATOLOGY DEPARTMENT OF MONASTIR (TUNISIA)
Authors: Bizid Inaam, Sarra Boukhriss, Zaouali Dridi Aya, Slama Nader, Wiem Boufrikha, Zaineb Mlayah, Adnene Laatiri
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: Multiple myeloma is a hematological malignancy that mainly affects older people. With the increase of life expectancy, the incidence of this disease has become higher. The evaluation of the current therapeutic protocol adopted in our country is essential to improve the prognosis of these patients. Aims: The aim of this study is to describe the epidemiological profile, diagnostic, prognostic and therapeutic aspects of multiple myeloma in elderly patients treated in our department. Methods: This was a descriptive retrospective and monocentric study, including elderly patients diagnosed with multiple myeloma treated at the Hematology Department of the University Hospital of Monastir (Tunisia) during the period between January 2015 and December 2021. Results: Thirty-eight patients, aged over 65 years, were included. We noted a slight female predominance with a sex ratio of 0.9. The median age of the patients was 70 years (range: 65 - 87 years). The median performance status (PS) was 2. Seventy-one percent of patients had a PS of 2 or higher. The median Karnofsky performance scale was 50%. The percentage of patients with a score greater than or equal to 50% was 59%. Regarding the Charlson Comorbidity Index (CCI), the median score was 2, and 55% of patients had an CCI greater than or equal to 2. Bone pain was the most frequent revealing symptom of the disease (37%). Both, anaemia and renal insufficiency revealed the disease in 24% of cases. IgG multiple myeloma was the most prevalent subtype (45%). According to the Durie Salmon staging system, 45% of patients were classified as stage IIIA and 35% as stage IIIB. For the International Staging System (ISS), the majority of patients had an ISS of 3 (60%). Eighty percent of the patients were treated with the MPT protocol combining Melphalan, Prednisone and Thalidomide. According to the International Myeloma Working Group (IMWG) criteria, very good partial response (VGPR) and partial response (PR) were noted in 20% and 52% respectively. Only 3% of patients had complete remission. Whereas, progression disease during treatment was noted in 6% of cases. Fifteen percent of patients died before the end of the induction treatment. Seventy-one percent of patients had at least one treatment-related complication. The most common complication was hematotoxicity (mainly neutropenia found in 64% of patients). Thirty-five percent of them complaint of paraesthesia in correlation with chemotherapy neurotoxicity. Febrile neutropenia complicated the treatment of 25% of the patients of which pneumonia was the most frequent infection. The median survival was 42 months. Overall survival was 56% at 3 years and 30% at 5 years. Summary/Conclusion: The therapeutic results of multiple myeloma in elderly patients in our country are poor due to the lack of availability of new treatments. Introducing the new therapies such as proteasome inhibitors and new immunomodulators in accordance with the international recommendations is essential for improving the therapeutic outcomes and the prognosis of these patients. Keywords: Multiple myeloma, Elderly